Pediatric and Adolescent Shoulder Instability

Abstract

Purpose of review: Traumatic and atraumatic shoulder instability is common in pediatric and adolescent patients. It is well-established that young patients with anterior shoulder dislocation are at high risk of recurrent instability. This review assesses the current literature pertaining to management of both anterior instability and MDI in the pediatric and adolescent populations.

Recent findings: Current research suggests that pediatric and adolescent patients with shoulder instability have excellent outcomes following arthroscopic Bankart repair; however, higher rates of recurrent instability requiring revision surgical management have been identified in patients with more than one dislocation episode pre-operatively, those with Hill-Sachs lesions and those under age 16. The addition of the remplissage procedure to an arthroscopic Bankart repair may be useful in preventing recurrent instability for patients with large Hill-Sachs lesions. Open procedures with bony glenoid augmentation may be indicated in patients with significant glenoid bone loss, or those who have failed primary surgical management, with promising outcomes reported following the Latarjet coracoid process transfer procedure in the adolescent population. Pediatric and adolescent patients with hyperlaxity, and those participating in swimming or gymnastics are more likely to have multidirectional instability (MDI). Non-surgical management with physical therapy is the mainstay of treatment for MDI with positive outcomes reported overall. In young patients with MDI who continue to have symptoms of instability and pain that effects daily activities or sports despite an adequate and appropriate course of rehabilitation, surgical management with capsulorrhaphy may be considered, with promising outcomes reported for both open and arthroscopic techniques. Attentive selection of timing and surgical procedure for pediatric and adolescent patients with anterior shoulder instability may help to prevent recurrent instability following shoulder stabilization. Although most pediatric and adolescent patients with MDI do well following non-surgical management alone, those that fail conservative management have good outcomes following arthroscopic or open capsulorrhaphy.

Keywords: Adolescent; Bankart; Glenohumeral; Instability; Pediatric; Shoulder.

Fig. 1

Arthroscopic images of a remplissage procedure for a large Hill-Sachs lesion in an adolescent athlete. A Large Hill-Sachs lesion. B Placement of suture anchor. C Sutures from two suture anchors through the posterior capsule and infraspinatus tendon prior to tensioning. D Tensioned sutures filling the Hill-Sachs defect with the posterior capsule and infraspinatus tendon

Fig. 2

Post-operative radiographs following a Latarjet procedure for a 15-year-old adolescent athlete with recurrent glenohumeral instability and glenoid bone loss following prior arthroscopic Bankart repair

Fig. 3

Arthroscopic images before and after anterior and posterior capsulorraphy using suture anchors in an adolescent patient with multidirectional instability (MDI)